Objective To compare advantage and disadvantage of internal fixation method for tibia intercondylar eminence fracture between absorbable screw and metallic screw. Methods From 1996 to 2002, 200 patients with fracture of tibia intercondylar eminence were divided into group A (with absorbable screw, n=120) andgroup B (with metallic screw, n=80). And the biological compatibility, biomechanics, bone union and complications were compared between two groups.Results There were no obvious differences in operating time and circumstance of recovery position between two groups. Group A was obviously better than group B in biological compatibility, biomechanics, bone union, joint function recovery. The average healing time of group A was three months, that of group B was three and half months. The good rates of joint function in two groups were 98.0% and 95.0% respectively. The occurrence rates of wound arthritis were 1.7% and 3.7%. There wassignificant difference between them(P＜0.01). Conclusion Absorbable screw is a more ideal material of internal fixation to treat tibia intercondylar eminence fracture.
Objective To provide the anatomic basis for thelag screw placement in the anterior column of the acetabulum. Methods Twenty-two pelvis specimens with 44 acetabula of the native adult cadavers were studied. The anthropometric measurement was performed on 44 acetabula to determine the shape of the transverse section of the anterior column of the acetabulum, the optimal entry point for the lag screw on the outer table of the ilium, the direction of the screw, and the distance from the entry point to the obturator groove. Results The transverse section of the anterior column of the acetabulum was almost triangle-shaped. The path for the lag screw placement was 10.5±0.8 mm in diameter. The optimal entry point on the posterolateral ilium for the screw fixation was found toexist 9.2±2.4 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 38.5±3.8 mm superior to the greater sciatic notch. The distance from the entry point to the obturator groove was 84.1±6.2 mm. The inclination of the lag screw was 54.2±5.5° at the caudal direction in the sagittal plane and 40.7±3.8° in the horizontal plane. The device for the safe screw placement in the anterior column was designed. Conclusion The above datacan facilitate an insertion of one 6.5 mm lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration, which has a narrow margin of safety. The safe length of the lag screw should be 70 mm.The optimal entry point on the posterolateral ilium for the screw fixationis determined to be 10 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 40 mm superior to the greater sciatic notch. The inclination of the lag screw should be 55° at the caudal direction in the sagittal plane and 40° in the horizontal plane. It is safe to place thelag screw in the anterior column with the help of the targeting device.
OBJECTIVE: To review the anatomic character of lower cervical pedicle, the placement and the biomechanical stability of the cervical pedicle screw fixation, the clinical application and the complication caused by fixation. METHODS: The literature concerned the cervical pedicle screw fixation in recent years were extensively reviewed. RESULTS: The cervical pedicle screw fixation can be widely used in the lower cervical spine instability according to the anatomic character of lower cervical pedicle, and the good biomechanical stability of the cervical pedicle screw fixation, and the complication can be controlled. CONCLUSION: The cervical pedicle screw fixation is an effective internal fixation for the lower cervical spine instability.
Objective To investigating the safety and accuracy of artificial intelligence (AI) assisted automatic planning of pedicle screws parallel to sagittal plane for C1. Methods The subjects who completed cervical CT scan in Zigong Fourth People’s Hospital btween January 2020 and December 2023 were selected. The subjects who completed cervical CT scan were randomly divided into two groups using a random number table method. Among them, 80% were used as the training model (training group), and 20% were used as the validation model (validation group). The original cervical CT data of the training group were imported into ITK-SNAP software to mark the feature points. Four feature points were selected. In order to obtain the weighted function model of the four feature points, training group were trained with the spatial key point location algorithm. pedicle trajectory based on the four key points obtained. Finally, the algorithm was compiled to form a visual interface, and imported into the verification group of annular vertebral CT data to calculate the pedicle screw trajectory. Results A total of 500 patients were included. Among them, there were 400 cases in the training group and 100 cases in the validation group. The average positioning error of spatial key points is (0.47±0.16) mm. The average distance between the planned pedicle screw center line and the internal edge of the pedicle was (2.86±0.12) mm. Pedicle screw placement parallel to the sagittal plane and 3D display can be safely performed for the C1 pedicle that is large enough to accommodate a 3.5 mm diameter screw without cortical breakthrough. Conclusions For pedicle screw planning parallel to the sagittal plane in C1, training based on the spatial positioning algorithm of anterior and posterior tubercles and bilateral tangential points can obtain a safe and accurate pedicle screw trajectory. It provides theoretical basis for orthopedic robot automatic screw placement. For vertebral bodies with narrow or deformed pedicles, further expansion of the training data is needed to expand the adaptive range and improve the accuracy of the algorithm.
Objective To explore the treatment of low-energy tibial plateau fractures with arthroscopic percutaneous osteosynthesis. Methods From May 2004 to April 2008, 27 cases of tibial plateau fractures were treated with arthroscopic management. There were 19 males and 8 females, aged 18-61 years old (mean 41.5 years old). Fracture was caused by trafficaccident in 18 cases, by fall ing from height in 6 cases, by bruise in 2 cases, and by other in 1 case. There were 8 cases of type I, 12 cases of type II, 2 cases of type III and 5 cases of type IV according to Schatzker classification. The time from injury to operation was 3-15 days (mean 5.2 days). After symptomatic managements were performed arthroscopically in 11 cases of meniscus tear, 4 cases of medial collateral l igament rupture of knee joint, 3 cases of anterior cruciate l igament rupture of knee joint and 2 cases of cartilage fracture resulting in joint bodies, fracture was reduced and fixed with 2 or 4 cannulated screws (7 mm in diameter). Autograft of il ium was given 6 cases of bone defect. Early functional exercise was done. Results The operation time was 55-150 minutes (mean 93 minutes); the hospital ization days were 7-22 days (mean 16 days). All incision healed primarily. Edema of the affected leg occurred in all patients and subsided after 3 days of symptomatic management. In one patient who did not cooperate in functional exercise, adhesion occurred and normal function was recovered after by manual dissolution under conditions of anesthesia after 3 months of operation. All patients were followed up 6-36 months (mean 16.6 months). The range of motion of knee joint was 105-140° (mean 121°). According to Lysholm scale of knee joint, the score was 72-100 points (mean 93.6 points) 6 months after operation. The X-ray film showed no signs of osteoarthritis. Conclusion Arthroscopic percutaneous osteosynthesis yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.
ObjectiveTo introduce a medical metal debris adsorption apparatus and to discuss the application value in removal of locking plate internal fixation.
MethodsBetween January 2011 and May 2013, 83 cases underwent removal of locking plate fixation. There were 44 males and 39 females, aged 21-59 years (mean, 35.4 years). The time from the first operation to internal fixation removal was 16-40 months (mean, 22.6 months). Thirty-two screws of 9 patients were removed difficultly due to slide fastener. The screws were removed eventually after plates and screws were separated by grinding locking screw with manganese steel drill. In the process of grinding, the medical metal debris adsorption apparatus was used in 16 screws of 4 patients (group A), and was not used in 16 screws of 5 patients (group B). The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues were compared between 2 groups. And the postoperative complications were recorded.
ResultsA total of 658 screws were removed, and 32 slipping screws were found, accounting for 4.86%. The lock screw slipping rates of 3.5 mm and 4.5 or 5.0 mm respectively were 6.53% and 2.31%; and the lock screw slip ping rates of internal fixation time < 2 years and > 2 years respectively were 3.21% and 6.08%. The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues of group A were significantly lower than those of group B (P < 0.05). Re-fracture (1 case) and incision infection (1 case) occurred in group B, and no complication was observed in group A. The cases of 2 groups were followed up 8-35 months (mean, 23.4 months). No heterotopic ossification occurred in both groups during the follow-up.
ConclusionThe medical metal debris adsorption apparatus can significantly shorten the operation time, reduce the residual metal debris and surgical bleeding when removing the slipping screws in removal of locking plate internal fixation.
ObjectiveTo investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture.
MethodsBetween January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed.
ResultsTwo patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05).
ConclusionA combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.
Objective To investigate the short-term effectiveness of proximal tibial lateral raft plate combined combined with or without Jail screw fixation in the treatment of tibial plateau collapse fractures involved posterior-lateral column. MethodsA retrospective analysis was performed on 106 patients (106 knees) with tibial plateau collapse fracture involved posterior-lateral column admitted between January 2016 and January 2021. According to the combination with Jail screw fixation or not, patients were divided into control group (treated by lateral raft plate without Jail screw fixation, 52 cases) and study group (treated by lateral raft plate with Jail screw fixation, 54 cases). There was no significant difference between the two groups in terms of gender, age, affected knee side, cause of injury, Schatzker classification, Tscherne-Gotzen classification, time from injury to operation, and preoperative lateral tibial plateau posterior slope angle (PSA), tibial plateau varus angle (TPVA), Rasmussen anatomical score (P>0.05). The operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, fracture healing time, complications, and lateral tibial plateau PSA, TPVA, Rasmussen anatomical score detected by X-ray films and CT before operation and at 1 year after operation of the two groups were recorded and compared. The number of cases of articular surface collapse in the two groups was recorded at 1 year after operation, and the effectiveness was evaluated by American Special Surgery Hospital (HSS) score. ResultsAll patients were followed up 12-32 months (mean, 19.5 months). There was no significant difference between the two groups in operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, and fracture healing time (P>0.05). There were 2 patients (3.7%) in the study group and 3 patients (5.8%) in the control group with superficial wound infection, which were cured after debridement and dressing change. There was no significant difference in the incidence between the two groups (χ2=0.252, P=0.616). There was no complication such as vascular and nerve injury, internal fixation failure, nonunion or malunion of fracture, and deep vein thrombosis of lower limbs in both groups. At 1 year after operation, 9 cases (17.3%) in the control group had joint collapse of 2-3 mm, while only 2 cases (3.7%) in the study group had joint collapse, showing significant difference (χ2=5.271, P=0.022). At 1 year after operation, the PSA, TPVA, and Rasmussen anatomical scores of the two groups were significantly improved when compared with preoperative ones (P<0.05); the differences of pre- and post-operative PSA, TPVA, Rasmussen anatomical score, and postoperative HSS score in the study group were significantly better than those in the control group (P<0.05). ConclusionThe lateral raft plate combined with or without Jail screw fixation can achieve satisfactory short-term effectiveness in the treatment of tibial plateau collapse fractures involved posterior-lateral column. Combined with Jail screw, it can enhance the fixation and avoid the occurrence of secondary articular surface collapse, which can be used as a better choice.
【Abstract】 Objective To investigate the effectiveness of surgical treatment for discogenic low back pain (DLBP) by minimally invasive transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation (UPSF). Methods Between March 2006 and July 2009, 57 patients with single-level DLBP were treated by minimally invasive TLIF combined with UPSF, including 27 males and 30 females with an average age of 45.6 years (range, 38-61 years) and a disease duration of 3.8 years (range, 9 months to 11 years). The involved segments included L2，3 in 2 cases, L3，4 in 5 cases, L4，5 in 29 cases, and L5, S1 in 21 cases. The operative time, incision length, intraoperative blood loss, postoperative drainage volume, hospitalization times, fusion rate, and complications were observed. The effectiveness were evaluated through Oswestry disability index (ODI) and visual analogue score (VAS), and the operative outcomes were compared in different groups classified according to various pressures of the contrast medium and sensitivities to discoblock after inducing consistent pain. Results The operation time, incision length, blood loss, postoperative drainage volume, and hospitalization times were (84.6 ± 37.4) minutes, (3.4 ± 0.6) cm, (132.5 ± 23.2) mL, (58.7 ± 21.4) mL, and (6.5 ± 0.8) days, respectively. All patients were followed up 2 years and 2 months to 5 years and 4 months (mean, 3.2 years). At last follow-up, ODI and VAS scores were significantly improved when compared with preoperative scores (P lt; 0.05). The effectiveness according to ODI were excellent in 27 cases, good in 22 cases, fair in 6 cases, and poor in 2 cases, with an excellent and good rate of 86.0%. All patients acquired b interbody fusion. At last follow-up according to ODI and VAS scores, better results were found in patients of low-pressure sensitive group and high-sensitive discoblock group (P lt; 0.05). Conclusion Minimally invasive TLIF combined with UPSF is reliable for DLBP with minimal surgical trauma, less paravertebral tissue injury, and fewer complications, but the indications for operation must be strictly followed. Patients being sensitive to low-pressure or high-sensitive to discoblock can achieve better surgical results.
